4 Major Differences Between ER Nurses and Floor Nurses

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There are many departments and different types of job positions in the hospital for nurses. Two floors that employ many nurses are the emergency department and the medical-surgical units. Let’s talk about the differences between ER Nurses and Floor Nurses.

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What is an ER Nurse?

An emergency department nurse is a healthcare professional who works in a fast-paced and challenging environment, providing care to patients who need immediate attention for a variety of medical conditions. They are skilled in assessing patient needs, administering medications and treatments, and collaborating with other members of the healthcare team to ensure the best possible outcomes for their patients. ED nurses are compassionate, dedicated, and always ready to respond to emergencies with a calm and reassuring demeanor, and provide attention and care to patients with less urgent needs.

What Does an ER Nurse Do?

The ER nurses have to work fast because every second is vital in saving someone’s life. They have to be able to quickly assess a patient’s condition and then act on that information. They also need to work well under pressure and make quick decisions. They must also be good at managing many patients at once, some of whom have simple and less urgent needs.

There is no predictability in the emergency room. You could have a shift where the unit is completely full, while another where there are only a few patients. There’s no way to know what’s about to walk through the door.

The number of patients an ER nurse cares for will be different each shift. The ER nurse may care for a few critically ill patients at the same time as other patients getting ready to go home.

The goal of the ER nurse and medical team is to figure out the problem as fast as possible, provide the appropriate testing/diagnostics, and treatments, and then get the patient discharged home if appropriate. If the patient is too sick to go home, then they are “admitted” into the hospital and will go to a medical-surgical unit, step-down unit, or critical care unit.

Specific Duties of Emergency Room Nurses

• Providing blood products and medications
• Providing care for traumas, cardiac arrests, strokes, and sexual assaults
• Washing and dressing wounds
• Conducting cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS)
• Releasing medically stable patients
• Educating sick individuals and their families about their disease and treatment plan
• Assisting in intubating patients
• Inserting IVs
• Assisting in setting fractures
• Stabilizing trauma patients
• Dealing with allergic reactions and critical injuries
• Safely transferring patients up to the medical-surgical unit, stepdown unit, or ICU

Average Emergency Room Nurse Hourly Pay

Following are the salaries stats of ER nurse practitioners according to Payscale.

• An entry-level Registered Nurse (RN) in the Emergency Room with less than one year of nursing experience can earn an average hourly compensation of $27.42 based on 681 salaries.
• An early career Registered Nurse (RN) in the Emergency Room with 1-4 years of experience earns an average hourly compensation of $29.57 based on 3,628 salaries.
• A mid-career Registered Nurse (RN) in the Emergency Room with 5-9 years of experience earns an average hourly compensation of $33.14 based on 2,436 salaries.
• An experienced Registered Nurse (RN) in the Emergency Room with 10-19 years of experience earns an average hourly compensation of $36.82 based on 2,303 salaries.
• In their late career (20 years and higher), employees make an average hourly compensation of $39.

Education Requirements for ER Nurse

To become an ER nurse, one needs to complete an associate’s degree in nursing (ADN) or a bachelor’s degree in nursing (BSN) from an accredited school, and pass the NCLEX-RN examination. For a more detailed explanation of the process of becoming a nurse, click here.

What is a Floor Nurse?

A floor nurse is an RN that works in a nursing unit that is not the ICU or stepdown units. They can work in any area of the hospital, such as medical-surgical, neuro or stroke floor, orthopedics, cardiology, cardiac med-surg, pediatrics, oncology, etc.

• ER nurses are working with the medical team to figure out what the heck is wrong
• ICU nurses will stabilize patients who are very ill and require constant monitoring
• Stepdown nurses care for patients who don’t need the constant watchful eye of the ICU, but are not stable enough to be on the floor
• Floor nurses care for medically stable patients who require additional monitoring, surveillance, and interventions but it’s not touch-and-go or an emergency

A floor nurse may discharge a few patients and later get some admissions. However, they will have a maximum number of patients they can safely care for in a shift at one time.

While the ER nurse provides care very focused on the reason they came in, the floor nurse provides broader care over a longer period of time. The floor nurse will perform a head-to-toe assessment, give medications, work with the medical team on the plan of care, and carry out the plan.

What Does a Floor Nurse Do?

While the mantra of the ER nurse is to “treat ’em and street ’em” (meaning, get the patient what they need and get them out the door or admitted to the hospital ASAP), floor nurses have a different focus. It’s not as much of a rush to figure out the problem and provide the care.

When patients are on medical-surgical floors, we often know what the problem is, or are in the process of figuring it out. We know the patient is sick enough to stay at the hospital overnight, and that they need constant medical supervision. If the patient isn’t critically ill, or close to it, then they can be on a medical-surgical unit, which is where the floor nurses will care for them during their stay.

Specific Duties of Floor Nurses

• Routinely assess patients (often once per shift and as needed)
• Monitor their medical status (vitals, labs, assessments)
• Work with the medical team on a care plan; implement the care plan
• Educate the patient on what’s happening, what to expect, how to prevent further issues, and more
• Administer treatment and medication
• Provide emotional support to sick persons and their families
• Schedule and coordinate tests and procedures

Average Hourly Pay of Floor Nurse

The pay scale of a floor nurse is very similar to the payment of an ER nurse. Please keep in mind that pay for nurses varies widely across the United States. I recommend looking at Payscale and noting your location for the most accurate estimate.

Education Requirements for Floor Nurse

The education requirements for a floor nurse are the same as the ER nurse. You need to be an RN, which means you either have an associate’s degree in nursing (ADN) or a bachelor’s degree in nursing (BSN) and have passed the NCLEX-RN examination.

What are the Main Differences Between Floor Nurses and ER Nurses?

Following are some significant differences between ER nurses and floor nurses.

Number of Patients

The main difference between ER nurses and floor nurses is the type and number of sick persons they see. ER nurses typically see more critical and life-threatening situations than floor nurses. Usually, ER nurses have a caseload of 5-10 sick persons at a time – with some having minor issues, and others having very life-threatening issues.

The ER nurse may see 30+ patients in one shift. You could start out with 10, but discharge 8 of them and send 2 to the ICU, and as you discharge and transfer patients, more come in! You never know how many you will have.

On the nursing floor, you’ll likely start with 4-7 patients, but not get more than that. You could discharge 2-3, and get 2-3 admissions back, but you may have some shifts where you start with 5 and have those same 5 patients all day! There is far less “throughput” in the medical-surgical units (meaning, patients coming into and leaving the unit).

Type of Patients

ER nurses will see patients of all levels of severity. They could see a patient who actually really doesn’t need to be in the ER but because it’s illegal to refuse treatment, have to address the issues anyway… all the way up patients actively coding. Also, depending on the hospital, ER nurses will see patients across the lifespan. Meaning, they could care for a 2-year-old that they are attempting to resuscitate after a drowning, to a 16 year-old post suicide attempt, all the way to a 98 year-old after a fall.

Floor nurses typically see one patient type. Unless it’s a pediatric department, floor nurses work specifically with the adult patient population. They also tend to suffer from similar issues. Cardiology nurses will care for patient suffering from cardiac-related issues, neuro floor nurses will care for patients suffering from neuro issues, ortho nurses care for patients recovering from orthopedic surgery, med-surg nurses care for patients suffering from medical and/or surgical problems, and so forth. Because of this, the floor nurse tends to become specialized in caring for that specific patient population. The ER nurse is more of a jack of all trades, whereas a floor nurse is a master of one.

Duties

There is some overlap in the duties of these nurses. Generally speaking, both will be assessing patients, working with physicians/the medical team, giving medications, helping with procedures, monitoring patients, and discharging/transferring patients.   However, the ER nurse will perform a wider array of duties. For example, ER nurses must know how to care for ventilated patients and assist with a chest tubes, arterial lines, and central line insertions.

Education

To become an ER or floor nurse, the education requirements are the same – ADN or BSN degree. Obtaining this degree requires passing the NCLEX. Some hospitals may require or strongly prefer a BSN degree, however, and if you’re hoping to work in a prestigious hospital, it might be harder to land a position in the ER. You will receive training specific to your unit on the job.

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Video on Differences Between ER Nurses and Floor Nurses

Ending Thoughts

In conclusion, both ER nurses and floor nurses are essential members of the medical field. They both have their own unique roles and responsibilities, which allow them to contribute to a sick person’s overall health and well-being. So whatever career you choose in nursing, know that you are making a difference.

More Resources

• TrueLearn– (use code FRESHRN for 15% off)
• What Do Emergency Nurses Do?
• Top Tips for New Emergency Department Nurses
• What Do Med Surg Nurses Do?
• Med-Surg Nursing: Top Tips for New Grads
• What’s the Difference Between CNA and RN?